SYMPTOM A TOLOGY—DIAGNOSIS 



1913 



part of the chest, fine crepitations or friction sounds may be 

 heard. 



Usually liver abscess is accompanied by some anaemia and some 

 increase in the number of the total leucocytes, but this appears to 

 vary, being greater if the abscess is small and deeply seated, and less 

 so if large and superficial. According to Rogers, the ratio of white 

 to red corpuscles varies from i : 517 to i : 126. With regard to the 

 differential count, the polymorphonuclear leucocytes are but slightly 

 increased, but the lymphocytes are usually more than normal. 

 Leger gives the differential count as being: Polymorphonuclears, 

 78-37 per cent.; lymphocytes, 17*44 per cent.; mononuclears, 3*15 

 per cent.; and eosinophiles, 070 per cent., which closely agrees 

 with Rogers' figures, which are: Polymorphonuclears, 74 to 87 per 

 cent. ; lymphocytes, 7 to 22 per cent. ; mononuclears, 3 to 7 per cent. ; 

 eosinophiles, 0 to 4 per cent. In some of our cases there was no 

 polymorphonuclear leucocytosis, while on several occasions, even in 

 non-malarial subjects, there was a relatively large mononuclear in- 

 crease. The number of sudanophile leucocytes tested according to 

 the Cesaris-Demel method is often increased. 



The urine is usually diminished, and its excretion is said to be 

 altered, so that the greatest quantity is passed between 12 midnight 

 and 12 noon, being especially increased in the early morning. 



If the abscess is allowed to continue its own course, it may burst 

 into the lung, causing signs of pleurisy and pneumonia, associated 

 with the expectoration of characteristic brown or reddish-brown 

 gummy, viscid, purulent matter; or into the stomach, when a 

 similar material will be vomited; or into the bowel, when it will 

 be passed per anum. It may also burst into the pericardium or the 

 peritoneum, or into the vena cava, all of which cases are bound to 

 end fatally. If it does not burst, the patient may die of exhaustion. 



The duration of a liver abscess is very variable, being from a few 

 weeks to several months, and even years. 



Diagnosis. — The diagnostic points in abscess of the liver are: A 

 history of dysentery; fever, generally of a serotine type, with 

 sweatings, not yielding to quinine; painful enlargement of the liver; 

 the characteristic pain in the shoulder; the rigidity of the right 

 rectus; the loss of movement in the right side of the diaphragm, 

 and the frequent cupola-shape of the liver on radioscopy; and, 

 above all, the discovery of the pus by exploratory puncture, as 

 described below. 



The differential diagnosis between the presuppurative and the 

 suppurative stages is often impossible without a puncture, but 

 sweating, high intermittent temperature, if present and not influ- 

 enced by the emetine treatment, is suspicious that suppurative 

 changes have begun. 



Pleurisy with effusion on the right side can be distinguished from 

 liver absciejss by the presence of Grocco's paravertebral triangle on 

 the left side. Moreover, in pleuritic effusions the upper limit of 

 the dulness is horizontal, while in liver abscess it is convex. 



